Successful switch to oral therapy with doxycycline in the case of an actinomycotic hepatic abscess

Petrache, Diana; Popescu, Gabriel-Adrian

doi:10.3855/jidc.2805

Cited by 3 publications

(2 citation statements)

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“…Fistulas to the skin (through the abdominal wall), the bronchial tree, the lung, and the pericardial space were described in a limited number of cases [9,13,39,62,87]. Rare complications included thrombosis or obstruction of the portal vein (n = 8) [29,43,45,[88][89][90][91], hepatic vein thrombosis (n = 3) [23,49,80] and inferior vena cava thrombosis or obstruction (n = 2) [23,81], cardiac tamponade (n = 3) [28,92,93], and gastrointestinal bleed (n = 1) [94].…”

Section: Review Of the Literaturementioning

confidence: 99%

A 60-Year Literature Review on Hepatic Actinomycosis

et al. 2022

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Hepatic actinomycosis (HA) is a rare infection with indolent course, atypical clinical manifestations, nonspecific laboratory and imaging findings and challenging diagnosis. We describe a case of a 35-y-old female who developed HA 2 weeks after gastrectomy. In addition, we analyzed clinical characteristics and outcome of 157 additional cases of HA identified in a 60 years’ literature review. Patients with HA were predominantly male (57%) and more than one-half were between 40 and 70 years of age. Of interest, the infection was cryptogenic in 80.8% of cases. Risk factors for HA were identified in 63.1% of the patients. Clinical presentation included fever (57.7 %), abdominal pain (52.1%), weight loss (45.1%), anorexia (27.5%), fatigue and chills (12.7% each), and malaise (12%) over a 2.35±3.5 months period. Leucocytosis, elevated alkaline phosphatase, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were the most frequent laboratory findings. Radiologic imaging revealed that the right lobe was more frequently affected (62.5%) with a single lesion found in two-thirds of cases. Diagnosis was achieved by histopathologic examination in 70.6% of cases. Cultures yielded Actinomyces in 45 instances, with A. israelii being the most frequent species. Less than one half of the patients were treated only with antibiotics, while the others received combined medical and surgical treatment. The median duration of antibiotic therapy was 135 days (range: 7-730 days). The presence of multiple lesions or solid tumor like lesions was significantly associated with medical therapy alone. The outcome was favorable in most cases (94%). Although rarely encountered, HA should be considered in patients with a chronic or subacute inflammatory process of the liver, in order to promptly diagnose and treat.

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Section: Review Of the Literaturementioning

confidence: 99%

A 60-Year Literature Review on Hepatic Actinomycosis

et al. 2022

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“…PHA occurs worldwide, but only 87 cases were reported in English literature between 1966 and 2015; none of them were from mainland China. This case prompted us to review PHA cases reported from mainland China in Chinese literature, and share the experience with the colleagues in the rest of the world.…”

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Primary hepatic actinomycosis mimicking liver tumour

Zeng

Zheng

Qunji

et al. 2016

ANZ Journal of Surgery

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A 38-year-old man was admitted to our hospital with a major complaint of 15-day abdominal pain in the upper right quadrant and intermittent fever of 38 C. Physical examination revealed tenderness in the upper right quadrant. Laboratory tests including white blood cell count, alanine aminotransferase, bilirubin and alpha fetoprotein were all normal. Computed tomography (CT) revealed an approximately 6 × 6 cm 2 hypodense mass in the left lateral segment of the liver. Enhanced CT scan of the mass demonstrated continued enhancement, that is, relatively low density in the artery phase and relatively high density in the equilibrium phase ( Fig. 1). The surface of the left lobe was blurred, leading to suspicion of a tumour infiltrating into the surrounding tissue. The above findings were highly suggestive of hepatic malignant tumour and thus surgical resection was scheduled. Intraoperatively, a firm mass of 6 cm in diameter at the base of segments II and III was found, which adhered to the anterior abdominal wall and diaphragm. There were yellowish nodules and necrotic tissue inside the mass. The left lobectomy of the liver was then performed. Macroscopically, the resected liver showed a yellowish-white mass that contained frequent pus-like areas. Histological examination revealed an abscess containing multiple aggregates of acute and chronic inflammatory infiltrates with florid fibrosis. Notably, several clusters of filamentous microorganisms consistent with actinomyces colonies (socalled sulphur granules) were present (Fig. 2). Filamentous bacteria were detected in the sulphur granules and positive for Gram staining. The overall features were those of primary hepatic actinomycosis (PHA). Thus, the diagnosis was confirmed to be PHA. The patient received intravenous cefoperazone for 7 days after the surgery and fully recovered and discharged. He was followed-up for 2 years and remained uneventful.PHA occurs worldwide, but only 87 cases were reported in English literature between 1966 and 2015; 1-6 none of them were from mainland China. This case prompted us to review PHA cases reported from mainland China in Chinese literature, and share the © 2016 Royal Australasian College of Surgeons ANZ J Surg 88 (2018) E629-E630

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A systematic review of case reports of hepatic actinomycosis

Chegini

Didehdar

Tabaeian

et al. 2021

Orphanet J Rare Dis

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Background Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately. Methods Case reports on HA in patients published between 2000 and April 2020 were gathered by carrying out a structured search through PubMed/Medline. Results Through a survey of the Medline database, 130 studies were identified and then, 64 cases with HA were included in the final analysis. Asia had the largest share of cases with 37.5% (24 reports), followed by Europe and the Americas. Affected patients were predominantly males (64%) and the overall mortality rate was 1% with only one male patient in his 50 s dying. Nearly all patients (92%) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (80%) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (32%) and foreign bodies in the abdominopelvic region (20%). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (66%), fever (62%), weight loss (48%), night sweat, malaise, and anorexia (14%) over about 3.1 months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in 18 patients (28%). Histopathologic examination confirmed infection in 67% of the patients and samples obtained from liver puncture biopsy (32%) were most frequently used in diagnosis. Surgery or puncture drainage + anti-infection was the most common method to treat patients and penicillin, Amoxicillin, Doxycycline, and ampicillin were the most frequently used drugs to control infection. Conclusion HA should be considered in patients with a subacute or chronic inflammatory process of the liver. With accurate and timely diagnosis of infection, extensive surgery can be prevented.

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Successful switch to oral therapy with doxycycline in the case of an actinomycotic hepatic abscess

Cited by 3 publications

References 4 publications

A 60-Year Literature Review on Hepatic Actinomycosis

A 60-Year Literature Review on Hepatic Actinomycosis

Primary hepatic actinomycosis mimicking liver tumour

A systematic review of case reports of hepatic actinomycosis

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